Guest guest Posted September 15, 2008 Report Share Posted September 15, 2008 Dear Colleagues, I have a patient who was injured in a fall while working in one of the Indian casinos. The insurer (Tribal First Insurance) said she had exhausted FMLA benefits and she was terminated. It does not sound like normal work comp procedure and I was wondering if the rules are different for these cases? Does anyone have recommendations for legal consultation? Thanks, Don , DC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 21, 2009 Report Share Posted May 21, 2009 , You are correct. The count starts on your first visit. You don't need a referral until you have gone beyond the 18 or 60 days. Ann Goldeen, Astoria Work Comp question Dear Docs, I have a patient who fell approx six weeks ago at work. She went to an urgent care facility the day of the fall and then to her primary MD two days after that. She just saw me yesterday for evaluation and treatment. Am I correct in assuming that I have either 18 visits or 60 days in which to treat her from the day of our first visit? Is there any issue related to her seeing her MD first? I don’t need him to give her a referral for chiropractic treatment at this point, do I? Thanks in advance for your help. Sorah, DC Corvallis, OR msorahnwhealing Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 21, 2009 Report Share Posted May 21, 2009 Hi , In response to your questions, yes you have 18 visits or 60 days whichever comes first and you can authorize time loss for 30 days. However, you must fill out a Form 827 marking the change of physician section and signed by the patient. Also if the patient is subsequently enrolled in a managed care organization likely Oregon Health Systems in your neck of the woods, the 18/60/30 no longer applies as the MCO's treatment guidelines trump the statutory 18/60/30. Which means you must after 12 visits fill out a pre-certification request form for OHS asking the medical director for additional chiropractic treatments if needed. Lastly if you are not a member of the MCO if and when the worker is enrolled into said MCO you still have 7 days from the date of the insurer's letter notifying you and the patient of their enrollment to treat them and gain reimbursement under the " continuity of care " provision. Colleagues, I have already been lobbying key MLAC and Legislative committee members relative to requiring the MCO's at a minimum at least duplicate statute which allows 18 visits and 60 days of chiropractic treatment before doctors must as the MCO medical director's for more treatment....the hope is to have said bill introduced and passed during the up coming Jan. 2010 special session..... Clear a mud? IF you have further questions feel free to call me on my cell today at 541-231-4528 Vern Saboe Work Comp question Dear Docs, I have a patient who fell approx six weeks ago at work. She went to an urgent care facility the day of the fall and then to her primary MD two days after that. She just saw me yesterday for evaluation and treatment. Am I correct in assuming that I have either 18 visits or 60 days in which to treat her from the day of our first visit? Is there any issue related to her seeing her MD first? I don't need him to give her a referral for chiropractic treatment at this point, do I? Thanks in advance for your help. Sorah, DC Corvallis, OR msorah@... <mailto:msorah@...> No virus found in this incoming message. Checked by AVG - www.avg.com Version: 8.5.339 / Virus Database: 270.12.36/2126 - Release Date: 05/21/09 06:22:00 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 21, 2009 Report Share Posted May 21, 2009 Hi , In response to your questions, yes you have 18 visits or 60 days whichever comes first and you can authorize time loss for 30 days. However, you must fill out a Form 827 marking the change of physician section and signed by the patient. Also if the patient is subsequently enrolled in a managed care organization likely Oregon Health Systems in your neck of the woods, the 18/60/30 no longer applies as the MCO's treatment guidelines trump the statutory 18/60/30. Which means you must after 12 visits fill out a pre-certification request form for OHS asking the medical director for additional chiropractic treatments if needed. Lastly if you are not a member of the MCO if and when the worker is enrolled into said MCO you still have 7 days from the date of the insurer's letter notifying you and the patient of their enrollment to treat them and gain reimbursement under the " continuity of care " provision. Colleagues, I have already been lobbying key MLAC and Legislative committee members relative to requiring the MCO's at a minimum at least duplicate statute which allows 18 visits and 60 days of chiropractic treatment before doctors must as the MCO medical director's for more treatment....the hope is to have said bill introduced and passed during the up coming Jan. 2010 special session..... Clear a mud? IF you have further questions feel free to call me on my cell today at 541-231-4528 Vern Saboe Work Comp question Dear Docs, I have a patient who fell approx six weeks ago at work. She went to an urgent care facility the day of the fall and then to her primary MD two days after that. She just saw me yesterday for evaluation and treatment. Am I correct in assuming that I have either 18 visits or 60 days in which to treat her from the day of our first visit? Is there any issue related to her seeing her MD first? I don't need him to give her a referral for chiropractic treatment at this point, do I? Thanks in advance for your help. Sorah, DC Corvallis, OR msorah@... <mailto:msorah@...> No virus found in this incoming message. Checked by AVG - www.avg.com Version: 8.5.339 / Virus Database: 270.12.36/2126 - Release Date: 05/21/09 06:22:00 Quote Link to comment Share on other sites More sharing options...
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